| NPI | 1083785281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WY 21113.785) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 264797-4406) |
| Enumeration Date | 2006-11-11 |
| Last Update Date | 2012-08-30 |